4 cm. of ileum protruding with catheter inserted and Daniel clamp at end. Sigmoidostomy stoma in lower pole of paramedian incision.
John Nyquist, Office of the VP for Health Sciences
4 cm. of ileum protruding with catheter inserted and Daniel clamp at end.
Rubber dam in perineal wound packed with gauze
Omentum is cut from its attachment along taenia omentalis and peeled from colon and mesocolon
Peritoneum has been incised along right side of bowel to midline at rectouterine pouch. Bowel is detached from sacrum and vagina by blunt dissection.
beginning well proximal to any inflammatory involvement of the ileum
Sigmoidectomy with open end-to-end anastomosis of descending colon to rectum
Solitary "true" Diverticulum - rarely encountered in the the large bowel - may simulate symptomatology of acute appendicitis.
Obstruction - gradual narrowing of the lumen is characteristic.
Diverticulum hidden by epiploic appendage
Appearance of diverticula from within lumen
Mobilizing the splenic flexure when the presence of diverticula necessitates removal of all or part of the transverse colon.
Long paramedian incision with self-retaining retractor provides good exposure.
Resection must extend to include every diverticulm as well as the area of diverticulitis!
Inflammatory ulcerations in bowel wall adjacent to diverticular opening
Ulcer in diverticulum eroding a nutrient artery
Extensive resection may be required to remove all diverticula - transverse colon is brought down and anastomosed to the rectum.
Closure with "figure-of-eight" sutures of alloy steel wire
Closure with "figure-of-eight" sutures of alloy steel wire - fascia, muscle, peritoneum, fascia, fascia, fascia.
Fistula - rupture into small bowel, vagina, anterior abdominal wall, or urethra may occur.
Mobilization of sigmoid - borken line indicates peritoneal incision - catheter in left ureter for identification while mobilizing an inflamed, adherent sigmoid.
Mobilization of the rectum by bluntly separating its posterior wall from the sacrum.
Fig. 5: Division of the ileum and sigmoid colon to form the permanent ileostomy and sigmoidostomy, respectively.
Right peritoneal incision to mobilize pelvic colon
Bowel deposited in presacral space and peritoneum closed
[Note on label attached to cover sheet:]
Fig. 7: C.: Dividing the right leaf of peritoneum in mobilizing the rectosigmoid and anterior dissection down to the posterior vaginal wall. Posteriorly the dissection is carried down to the coccyx.
D.: Stump of sigmoid colon and mobilized rectum are deposited in the presacral space and peritoneal floor reconstructed.
Division of the mesentery, illustrating the ligation of the principal blood vessles [sic]
Fig. 4: Division of the mesentery, illustrating the ligation of the principal blood vessles [sic].
Omentum peeled from trans. colon and mesocolon
Combined Abdominoperineal Excision of the Rectum
Fig. 6: Combined Abdominoperineal Excision of the Rectum.
A.: Left paramedian incision with removal of old scar.
B.: Dividing the left leaf of peritoneum in mobilizing the rectosigmoid.
Long thin mesentery facilitates twisting
Black and white wash on illustration board
Elastic bandages on lower extremities prevent pooling of blood.
The subcostal incision extended across the midline provides for good exposure and strong closure
peritoneum is incised along lateral paracolic gutter from pelvis to splenic flexure.
Pul. Vv. & Atrium opened showing various communications
Viewed from in front and slightly from right side
Anomalous Pulmonary Aa. (enlarged bronchial Aa.)
Rigid fibrous calcific ring encircling the heart
Looking into the left atrium at the stenosed mitral valve.
Pulmonary A. arising from left ventricle